NOTE: WE REQUEST THAT PARISHES AND SCHOOLS DO NOT USE THE RALLY AS A SUBSTITUTE FOR A CONFIRMATION RETREAT.

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2 M E M O TO: FROM: CYMs, DREs and Middle School/Jr. High Principals Clare Kolenda, Middle School Youth Rally Coordinator Brian Flynn, Office of Youth Ministry DATE: January, 2018 RE: Middle School Youth Rally" Enclosed with this mailing are registration brochures, posters, group registration form, instructions for adult leaders and drivers, maps, and permission forms for the Diocesan Middle School Youth Rally on Saturday, March 10 th at Lumen Christi High School, Jackson, Michigan. Event is 10-5 PM. Doors open at 9:30 A.M. All youth in the 6th, 7th, and 8th grades are invited to attend, but they must be registered as part of a parish/school group or chaperoned by their parents, who must also be VIRTUS compliant. Please read the enclosed step-by-step instruction sheet very carefully so you can follow the proper procedures in registering and preparing your youth and adult leaders for participation. Because the responsibility for middle school religious education and activities often overlap, we are sending this information to all DREs, CYMs, and principals of middle schools. Please coordinate publicity, registration, and supervision with the other administrators from your parish. If you have any questions, please contact Brian Flynn at The registration fee for the rally is $30.00 with a deadline of February 23, Registration after that date is $40.00, with final registration no later than Wednesday, March 7, T-shirts will be available for $10 prior to late registration. A limited number of shirts will also be available at the event. We are only sending one group registration form, permission form, and medical release form. Please duplicate them according to your needs. Please have one adult come to the registration table to check your group in. Each youth will need a permission form signed by his/her parents, and a medical release form. Group leaders will bring the forms to the registration table upon arrival for check-in, give the permission forms to the on-site registrant, then keep the rest of the forms with you at all times during the event. Thank you for your interest in bringing our young church to this event. For further information or questions you may call Brian Flynn at NOTE: WE REQUEST THAT PARISHES AND SCHOOLS DO NOT USE THE RALLY AS A SUBSTITUTE FOR A CONFIRMATION RETREAT.

3 Steps to Prepare for Middle School Youth Rally March 10, Announce the event to your middle school youth. Invite them to participate. Invitations can be made through Religious Education classes, youth meetings, personal phone calls, bulletins, newsletters, etc. Announcements at Masses will be helpful also. 2. Collect the individual registration forms in your parish or school. Please coordinate the registrations between the parish school, religious education, and youth ministry programs. Place the names and grades on the Group Registration Form included with this packet. Please include your adult chaperones in your count; they must also be paid for. A single check for the total number of registrations (including adults) should be made out to the Diocese of Lansing. Send the Group Registration Form ONLY along with the check, with the note Middle School Rally, for your total amount to: Middle School Rally - Diocese of Lansing Registrar 228 N. Walnut Street Lansing, MI NOTE: The early registration deadline at $30.00 per person is due February 23, After that date, the cost of registration will be $40.00 per person. Cut off registration date is March 7, There will be no refunds; replacements will be accepted. 3. Remember to recruit chaperones for your youth. Chaperones should be adults who are at least 21 years old. You should have one chaperone for every eight youth. Chaperones must be VIRTUS compliant. Chaperones should come prepared to be actively involved in all of the activities of the Rally with their youth. This is an excellent opportunity for your adult leaders and youth to get to know each other better. 4. Make sure each youth has a permission slip signed by his/her parent or guardian stating that he/she can participate in the Youth Rally. Group leaders will bring these forms to the registration table for check-in, then keep the forms with them throughout the day. All adults who are drivers should have copies of the permission slips for those youth riding to and from the Rally with them. A sample permission form, which can be copied, is enclosed. 5. All drivers must be over 21 years of age, and must fill out a Driver Information Form which you should keep in your records. 6. Meet with your youth beforehand to go over the code of behavior printed on the Youth Rally Instruction sheet included with this packet. You and your chaperons are responsible for the youth from your parish/school. Please review the guidelines with those attending. 7. It is recommended that each parish should subsidize the cost of the registration fee for their youth. You may wish to do special fund raising activities or ask for support from a group such as Knights of Columbus or Council of Catholic Women in your parish. 9. T-SHIRT PRE-SALE: We will be taking pre-sale orders on t-shirts by the early registration date. Please indicate on the group registration form the quantity per size and total number of t-shirts X $10.00 for your group. Pre-sale t-shirt orders will only be accepted by the early registration date of February 23, After that date, a limited number of t-shirts will be sold on a first-come, first-serve basis at Rally. The participant T-shirt will have a similar design to the poster.

4 YOUTH RALLY INSTRUCTIONS Adult Leaders and Drivers 1. You are responsible for the safety of the youth who ride with you. Please drive safely and defensively. Have youth use seat belts. The designated supervisor should inform you about your route and plans for traveling together. 2. Only one person from your parish/school needs to go to the registration table in the lobby to pick up your registration materials. Each member of your group, both youth and adults, will receive a wristband. The wristband must be worn for the entire day. 3. We are counting on your help for enforcing the following code of behavior for all participants: 1. Let all your actions and words contribute to the enjoyment of the Rally for everyone. Be your best self, representing your parish or school and yourself to the best of your ability. 2. Participants must attend all of the activities during the day. 3. Wrist bands must be worn at all times. If you wish you may provide your own name tags. 4. No participants will be permitted to leave the grounds of Lumen Christi High School during the rally. 5. No foul language. 6. Smoking is not permitted for any participants, youth, or adults during the Rally. 7. No alcohol or other drug is to be brought or consumed during the Rally. 8. No throwing objects or other disruptions during the sessions. 9. Participants are not allowed to leave the premises for any reason. 10. No cell phones or pagers are allowed. 11. If any participant does not observe these guidelines, his/her parents will be called to make arrangements for the person to leave the Rally early. If you notice a violation of these guidelines please inform any one of the committee members or their parish coordinator of youth ministry. 4. Please help your youth stay on the announced schedule and arrive on time for all activities. Your enthusiastic participation in all of the activities will be a model for your youth. 5. A First Aid station and Lost and Found will be set up and available during the day. Location will be announced at the beginning of the Rally. 6. Rally committee members will have a special T-shirt on. They are here to help make this day a good experience for everyone.

5 GROUP REGISTRATION FORM FOR MIDDLE SCHOOL RALLY 2016 Greetings in Christ! We have decided to register groups for Rally by number per parish and not by individual name. The reasons are as follows: If a C Y M has som eone drop out they can replace them w ithout notifying us. They save money for the parish, time for the CYM and our office, and relieves the stress of trying to handle so many changes the week of the event. N o need to fax nam es in. Paym ents need to be included with all registrations including additions. Please use only this form to register all the youth and adults from your parish who will be attending Rally Remember, you must have one adult for every ten youth who attend. Return this form together with your payment to: Registrar, Diocese of Lansing, 228 N. Walnut Street, Lansing, MI Parish Name & City: Parish Contact: Address: Total number of youth X $30.00 (early deadline of 2/23/18), $40.00 after early deadline. Total number of adults X $30.00 (early deadline of 2/23/18), $40.00 after early deadline. T-Shirt Pre-Order with Payment of $10.00 (early deadline of 2/23/18) per T-shirt X total T-shirts = Total due with this registration form includes adult, youth, and T-shirt payable to Diocese of Lansing. (Ex: 20 youth, 4 $30.00, 24 $10.00 = $960.00) Small Medium Large XL XXL Special Needs (name of person and special need; i.e., food allergy or physical challenge): * * *

6 HEALTH HISTORY AND MEDICAL RELEASE FORM FOR PARISH PROGRAMS AND ACTIVITIES Participant s Name Sex Birth Date Age Parent/Guardian Relationship to participant Street Address City State Zip Code Home Telephone ( ) Work Telephone ( ) H E A L T H H I S T O R Y Family Doctor Telephone Number ( ) IMMUNIZATIONS (Record YEAR of last immunization or last time person had disease): Tetanus/Diphtheria Measles Mumps Chicken Pox Rubella Polio TB (results) Hepatitis B Other SPECIAL INFORMATION: (Please check all that apply. Information will be held in strict confidence.) Sleep Walking Fainting Dizziness Blackouts Asthma Kidney Problems Frequent Nosebleeds Frequent Colds Seizures Severe Headaches Diabetes Severe Homesickness Frequent Earaches ALLERGIC REACTIONS (Please list all known allergies - plant, insect, food, medicine AND TYPE OF REACTION): Please indicate any other medical problems/situations pertinent to your child: Any physical limitations? If yes, explain Any emotional/psychological limitations or reactions to be aware of? If yes, explain: Is the student presently taking any medication? All medication is to be well labeled with clear, concise directions indicated here (frequently, dosage, etc.): In an EMERGENCY, and if unable to reach parent/guardian, we should contact: 1. Name Telephone Number ( ) 2. Name Telephone Number ( ) PLEASE FILL OUT BOTH SIDES

7 Note to parent/guardian: Please read the following sections carefully. We apologize for the complexity but we must be sure we have your full consent in these areas as well as, having this document notarized. PERMISSION FOR ROUTINE MEDICAL TREATMENT All attempts will be made to notify you if your child requires medical treatment (i.e., cases of high, persistent fever; severe vomiting, etc.). Please indicate whether or not you wish attempts to be made to contact you if your child becomes ill with minor symptoms (i.e., headache, sore throat, low-grade fever, etc.). YES NO NOTE: If you do wish to be contacted and it is not a local call, the charges shall be reversed to you. We do not wish to give any medical treatment to your son/daughter against your wishes or family practice. Please read each of the following statements carefully and sign only either A or B which is in accord with your wishes: A) I grant permission for non-prescription medication (i.e., Tylenol, cough syrup, etc.) except for the following to my student if deemed advisable by the designated supervisor, and I grant permission for routine non-surgical medical care to be given to my student, if deemed advisable by the designated supervisor(s). * SIGNATURE DATE or B) I do not want ANY type of medication administered to my child unless the situation is life-threatening and emergency treatment is required. * SIGNATURE DATE PERMISSION FOR EMERGENCY MEDICAL TREATMENT In case of emergency, I hereby give permission to transport my child to the nearest hospital/emergency center for emergency medical or surgical treatment. I will be contacted as soon as possible and will be advised prior to any further treatment by the hospital or doctor. *SIGNATURE DATE FAMILY INSURANCE PROVIDER/HEALTH PLAN HEALTH PLAN NUMBER (Include expiration date):

8 PARENT PERMISSION FORM FOR DIOCESAN MIDDLE SCHOOL RALLY Dear Parent or Legal Guardian: Your son/daughter is eligible to participate in a parish/school sponsored activity requiring transportation to a location away from the parish building. This activity will take place under the guidance and supervision of authorized personnel from parish/school, city. A brief description of the activity follows: Name of the Event: Diocesan Middle School Rally Destination: Lumen Christi High School, Jackson, Michigan Date of Departure: March 10, 2018 Time of Departure: Date of Return: March 10, 2018 Anticipated Time of Return: Method of Transportation: Designated Supervisor of Activity: Student Cost: Emergency Phone Number: If you would like your child to participate in this event, please complete, sign, and return the following statement of consent and acknowledgment. As parent or legal guardian, you remain responsible for any legal responsibility which may result from actions taken by the named student. Keep this section for your information. Please be advised that there are no cell phones or pagers allowed into the event. Adults will have cell phones for emergency purposes. Also, if the youth leave the premises for any reason they will be sent home PERMISSION FORM FOR DIOCESAN MIDDLE SCHOOL RALLY PARTICIPATION I hereby consent to participation by my son/daughter, in the Diocesan Middle School Rally on March 10, I understand the event described in the upper portion of this sheet, including all the details mentioned. I consent to my son/daughters participation. I understand that no event, including the one described above, is without risk of significant injury. Nevertheless, on behalf of myself and my child, I voluntarily waive any liability of any sort that might arise on the part of the Catholic Diocese of Lansing, and Lumen Christi H.S., or any cleric, administrator, teacher, employee, volunteer, agent, chaperone, parent, or student, in connection with this event. My signature attests to my understanding, consent, and waiver, as set forth in this paragraph. (print parent's name) (parent's signature) (date) MEDICAL INFORMATION My child is allergic to : My child must take the following medication (indicate dosage, frequency, etc.): Please note specific medical problems (use back if necessary): In case of emergency notify (include phone number): If the above person is unavailable notify: I grant permission for non-prescriptive medication (e.g. Tylenol, throat lozenges, cough syrup, or Pepto- Bismol); and routine nonsurgical medical care to be given to my child if deemed advisable by the supervising parish/school personnel. In case of an emergency, I also grant permission to transport my child to the nearest hospital for emergency medical or surgical treatment. I will be contacted as soon as possible and will be advised prior to any further treatment by the hospital or doctor. Signature Date Family Health Plan & Number